Terlipressin in the treatment of late phase catecholamine-resistant septic shock.

Background/aims: Norepinephrine, but also dopamine and epinephrine are recommended as first line vasopressors in the treatment of septic shock. In some patients, septic shock deteriorates and becomes to be resistant to catecholamines. In this situation, addition of vasopressin or terlipressin can be advantageous.

Our experience with transoral incisionless plication of gastroesophageal reflux disease: NOTES procedure.

Background/aims: Natural Orifice Transluminal Surgery (NOTES) has been introduced in endoscopic surgery as a new system offering the advantage of a less invasive procedure. Gastroesophageal reflux disease (GERD) appears to be the most promising application of NOTES treatment. The aims of our study were to evaluate the safety and efficacy of this procedure and length of hospital stay.

Therapeutic influence of 20 % albumin versus 6% hydroxyethylstarch on extravascular lung water in septic patients: a randomized controlled trial.

Background/aims: Recent studies demonstrated that extravascular lung water (EVLW) is a reliable and independent marker for outcome. The primary therapeutically goal in critically ill patients is to resuscitate and retain adequate organ perfusion by fluid administration, where is necessary to achieve adequate intravascular filling, but avoid initiation of pulmonary edema.

Methodology: Patients with severe sepsis were randomly allocated to a group treated with 20% Albumin 100 ml every 12 hours (ALB; n = 30) or with 6% hydroxyethylstarch 130/0, 4 250 ml every 6 hours (HES; n = 26).

Prognostic and diagnostic accuracy of [18F]FDG-PET/CT in 190 patients with carcinoma of unknown primary.

Purpose: The aim of the study was to determine the accuracy of [(18)F]fluorodeoxyglucose (FDG) PET/CT in the search for the primary and the presence of a malignancy. The prognostic value of FDG-PET/CT information was tested.

Methods: A total of 190 patients were retrospectively analysed: 82 with histologically proven metastases (HPM) and 108 with clinical suspicion of the presence of a malignancy (CSM).

Can procalcitonin help us in timing of re-intervention in septic patients after multiple trauma or major surgery?

Background/aims: In surgical sepsis, the rapid identification of source of infection at an early stage after surgery or serious trauma is crucial for favorable outcome. The discrimination between local and generalized infection is critical for correct treatment.

Methodology: In a randomized, controlled, single-centre study we investigated 72 patients with severe sepsis after major abdominal surgery or surgery for multiple trauma.

[Postoperative pulmonary thromboembolism and nosocomial pneumonias: differential diagnosis].

After a surgical intervention patient can face pulmonary complication that was formerly recognised as postoperative pneumonia. This term described the clinical picture which was diagnosed after abdominal or thoracic operations, after polytraumatic lesions, especially with elderly patients that were for a longer time confined to bed rest. The clinical symptoms incl.

Langerhans cell histiocytosis with central nervous system involvement: follow-up by FDG-PET during treatment with cladribine.

The prognosis of patients with Langerhans cell histiocytosis (LCH) involving the central nervous system (CNS) is generally poor, despite reports of clinical responses to chemotherapy, surgery, and radiation. We report on a patient with a 20-year history of relapsing multisystem LCH who developed progressive neuropsychiatric symptoms, including diplopia, ataxia, and mental deterioration. There was a regression of lesions in the brain stem and cerebellum following chemotherapy with cladribine (2-CdA) as evidenced by positron emission tomography (PET) scans.

Stress ulcer prophylaxis in critically ill patients: a randomized controlled trial.

Background/aims: Critically ill patients especially who require mechanical ventilation or have coagulopathy are at increased risk for stress-related gastrointestinal hemorrhage. There are conflicting data on the efficacy and complication rates of various prophylactic regimens.

Methodology: Our single-center randomized, placebo-controlled study included 287 patients with high risk for stress-related upper gastrointestinal hemorrhage (>48 h mechanical ventilation, coagulopathy).

Helicobacter pylori is not a risk factor for stress ulcer bleeding in polytraumatized patients.

Background/aims: The pathogenesis of acute stress-related hemorrhage in critically ill polytraumatized patients is uncertain and any role of Helicobacter pylori infection is unknown. The aim of our study was to evaluate the relationship between Helicobacter pylori serological status of patients developing stress-related bleeding and those with no appearance of upper gastrointestinal bleeding.

Methodology: In our single-center prospective cohort study we investigated over a 3-year period all consecutive patients with upper gastrointestinal hemorrhage for Helicobacter pylori infection by serology.

Routine (18)F-FDG PET preoperative staging of colorectal cancer: comparison with conventional staging and its impact on treatment decision making.

Unlabelled: The preoperative staging of colorectal cancer (CRC) with (18)F-FDG PET is not as yet generally considered to be evidence based. We have found only 1 study that evaluated (18)F-FDG PET in a nonselected population with proven CRC. Several other studies have concentrated on more advanced disease.

Attenuation correction stress myocardial SPECT: possibility of reduction in number of rest investigation.

Background: Attenuation-corrected (AC) imaging frequently shows normal stress myocardial perfusion while non-corrected (NC) imaging shows hypoperfusion. The aim of the work was to assess whether it is necessary to continue with resting examination in this situation.

Material And Methods: 121 consecutive patients had positive finding at AC and/or NC sestamibi stress myocardial imaging using E.

Brain metastases after stereotactic radiosurgery using the Leksell gamma knife: can FDG PET help to differentiate radionecrosis from tumour progression?

Stereotactic radiosurgery (SRS) using the Leksell gamma knife promotes acute and chronic local changes in glucose metabolism. We have been able to find very few papers on Medline on the subject of assessment of metastases by 2-[(18)F]fluoro-2-deoxy- D-glucose positron emission tomography (FDG PET) after SRS. The aim of this work was to specify the additional value of FDG PET, in comparison with magnetic resonance imaging (MRI), in differentiating SRS-induced radionecrosis from viable brain metastasis in a clinical setting.

[CRASH--the first large randomized controlled study of head injuries].

CRASH (www.crash.lshtm.

[Preventive sclerotherapy of esophageal varices with a high risk of hemorrhage: a prospective randomized controlled study].

Endoscopic sclerotherapy (ES) is known to be effective in the treatment of bleeding esophageal varices, but the efficacy in the prophylaxis of first variceal bleeding has not been clear yet. The aim of this study was to investigate the frequency of first variceal bleeding, eradication and recurrence of varices, and survival after treatment with ES compared to non-treated control group. A total of 104 patients with liver cirrhosis and advanced esophageal varices with no previous history of upper gastrointestinal bleeding were randomly assigned to either endoscopic sclerotherapy group--SKL n = 56, or non-treated control group--KON n = 48.

[Does insufflation of the abdomen in laparoscopic surgery affect acid-base and ventilatory parameters?].

The cardiopulmonary and metabolic changes experienced by patients undergoing laparoscopic cholecystectomy with CO2 pneumoperitoneum are not well understood. The purpose of this study is to determine changes of basal parameters during laparoscopy and evaluate their prognostic value. One hundred patients (26 obese, 39 older than 60 years, 7 obese and older than 60) undergoing laparoscopic cholecystectomy for uncomplicated cholecystolithiasis were included in the study.

[Changes in acid-base equilibrium, ventilation parameters and immunologic reactions in thoracoscopic operations].

In the thoracoscopic operations it is usually necessary to deflate completely the ipsilateral lung. The aim of this study was to determine changes of blood gases and alterations of immune response mediators during thoracoscopic surgery with one-lung ventilation OLV. In the study 38 patients were included undergoing thoracoscopic or video-assisted thoracic surgery.

A prospective randomized controlled trial of sclerotherapy vs ligation in the prophylactic treatment of high-risk esophageal varices.

Background: Endoscopic ligation (EVL) and endoscopic sclerotherapy (EIS) are both effective in the treatment of bleeding esophageal varices, but the efficacy of the two techniques in the prophylaxis of first variceal bleeding has not been investigated. The aim of this study was to investigate the frequency of first variceal bleeding, the recurrence of varices, and survival after treatment with the two techniques, as compared to a nontreated control group.

Methods: A total of 157 patients with liver cirrhosis and advanced esophageal varices with no previous history of upper gastrointestinal bleeding were randomly assigned to either an EIS group (n = 55), an EVL group (n = 52), or a nontreated control group (n = 50).

Benefit of prophylactic endoscopic sclerotherapy of esophageal varices. A retrospective analysis.

Background: The therapeutic schedule in bleeding esophageal varices is today established: emergency endoscopy with sclerotherapy or ligation combined with somatostatin and decreasing portal pressure drug followed by repetitive sclerotherapy or ligation. But the approach to varices that do not bleed is not clear.

Methods: The authors submit the results of a 6-year sclerotherapeutic program.

[Recurrent source of bleeding in patients with esophageal varices].

During last 7 years were in Endoscopic Centre of Brno Traumatologic Hospital treated 824 patients (624 male, 200 female) with esophageal varices, indicated to endoscopic sclerotherapy, ligation, or tissue adhesive injection. For one or more episodes of bleeding were treated 659 patients and resting 165 received therapy prophylactically. Recurrent acute bleeding from upper GIT occurred from 1 January 1990 to 30 April 1997 in 212 of them.

[The response of methylprednisolon therapy to interleukin-6 release in spinal injuries.].

The prospective study continues the investigations published in "Dynamics of Cytokines in the Blood and Liquor at the Spinal Injured Patients". In previous publication we documented a statistical significant dependence of IL-6 concentration in the blood and liquor to various degrees of neurological lesion classified by Frankel scale. We followed the influence of Methylprednisolon (Solumedrol, UpJohn) therapy to the IL-6 level in blood and liquor, as the supposed selective mediator for spinal trauma.

[Dynamics of cytokines in blood and liquor at the spinal injured patients.].

Authors followed the increase of cytokines concentration in blood and liquor at spine injured patients. The degree of the neurological damage was classified according to Frankel scale. Mediators: IL-1, IL-2, IL-6, TNF-alfa, Cortisol were investigated.

Pantoprazole-based dual and triple therapy for the eradication of Helicobacter pylori infection: a randomized controlled trial.

Background/aims: The eradication of Helicobacter pylori (Hp) infection in duodenal ulcer and dyspepsia has been achieved using various therapy regimens. The efficacy of protein pump inhibitor pantoprazole as part of these regimens has not been widely studied.

Methodology: During a prospective randomized trial, 250 Hp positive patients with either duodenal ulcer, erosive bulbitis, or gastritis and dyspepsia were treated using 14 days of therapy 1) pantoprazole 40 mg daily and clarithromycin 500 mg b.

Recent position of transjugular intrahepatic portosystemic shunt in the treatment of portal hypertension.

Transjugular intrahepatic portosystemic shunt (TIPS) is a side-to-side portocaval shunt for threatening complications of portal hypertension. TIPS effectively decreases portal hypertension connecting the hepatic and portal vein with an expandable metal stent without the mortality and morbidity of an open surgical procedure. Technical success can be achieved in over 90% of patients, with procedure related mortality of 1-2%.

[Transjugular intrahepatic portosystemic shunt in the treatment of complications in portal hypertension].

Transjugular intrahepatic portosystemic shunt (TIPS) is a side-to-side portocaval shunt for threatening complications of portal hypertension. The purpose of this study was to evaluate in first 33 patients indicated for TIPS insertion in our institution the efficacy, complications, and mortality. Indication was failure of sclerotherapy or ligation in control either of acute (n = 4) or repetitive (n = 25) variceal bleeding and refractory ascites (n = 4).

[Trauma and emergency thoracoscopy].

Authors present their first experience with urgent videothoracoscopy in polytraumatism and in isolated thoracic trauma patients. During the prospective study in 1993-1995 thoracoscopically was treated 41 (18%) from 229 multiple trauma patients including thorax trauma, hospitalised in our Institute. Thoracoscopy underwent 62 (4%) from 1452 patients with simple thoracic trauma.